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While I’ve been busy writing a couple of stories on different topics, you’ve probably heard two pieces of news that will affect healthcare providers nationwide: the close of the first open enrollment period for Patient Protection and Affordable Care Act insurance exchanges and the Congressional “fix” (read “Band-Aid”) to the Medicare sustainable growth rate that statutorily delays the ICD-10 compliance deadline for another year, until October 2015.

The White House yesterday reported that 7.1 million people had signed up for health insurance through healthcare.gov or state-run exchanges, barely exceeding the Congressional Budget Office’s projection of 7 million. Independent tracking site ACAsignups.net says it’s more like 7.08 million, but still just above the goal. That site also tallies the following sign-ups as a result of the ACA:

4.71 million – 6.49 million through Medicaid/Children’s Health Insurance Program expansions;

2.5 million – 3.1 million “sub-26ers,” young adults whom the ACA allows to stay on their parents’ health insurance until age 26; and

1.8 million “woodworkers,” those who came out of the woodwork because they did not know before the Obamacare enrollment push that they were eligible for Medicaid or CHIP.

ACAsignups.net places the total range at 14.6 million – 22.1 million as of March 31, not counting the healthcare.gov numbers, though my math puts it at 15.38 million – 22.06 million. Add in the healthcare.gov sign-ups and you get about 22.5 million to nearly 29 million newly insured people. However — and this is a big however — we do not know how many of the beneficiaries are newly insured and how many were replacing previous coverage.

Personally, I bought a high-deductible, ACA-qualified health plan through an independent agent to replace a rather restrictive high-deductible plan that was grandfathered in, and should save about $70-$80 a month on premiums starting in May. The new insurer rejected me several years ago due to a pre-existing condition; the ACA assures that I can’t be denied for that reason anymore. I imagine there are millions in the same boat as I am.

The U.S. Census Bureau placed the number of uninsured for 2012 at about 48 million, or 15.7 percent of the population. (The same year, 198.8 million had private insurance.) Until we see new figures for uninsured Americans, we will still just have “gross” statistics, not a net figure to show if the insurance part of the ACA is working.

By the way, the ACA is about much more than insurance coverage, despite what the national media have focused on. I encourage you to read up on this before you say Obamacare is saving or ruining our country.

Now, as for the temporary SGR fix, the ICD-10 delay kind of came out of nowhere last week when it got slipped into the House version of the legislation, but the Senate adopted the same language — reportedly without debating ICD-10 at all — and President Obama today signed it into law. I’ve said before that ICD-10 and other transactional elements of healthcare stopped mattering to me as I watched my dad being mistreated in a hospital due to broken clinical processes in his last month of life. I still think this way. However, this sneaky move shows that the AMA, AHA and other groups more intent of protecting the status quo than fixing healthcare still have enormous sway in Washington.

It makes me wonder whether lobbyists haven’t already started pushing hard for Congress to delay the Medicare penalties for not achieving Meaningful Use that are due to kick in next year. Actually, I don’t wonder. I’m sure it’s happening.

All delaying real reform of a broken industry does is prolong the agony, and ensure that millions more people will be affected by errors and neglect in institutions that are supposed to “do no harm.” The status quo is not acceptable.

I normally shy away from stories about the crowded and, to this point, spectacularly unsuccessful field of untethered personal health records, but one got my attention this week because of the names it’s just attracted.

Box, a cloud-storage company that offers something similar to Dropbox or Google Drive, has hired former White House CTO Aneesh Chopra and former Allscripts CEO Glen Tullman to, according to VentureBeat, “help the company push into the notoriously tricky health care vertical.” That’s an understatement. (Full disclosure: I serve on the advisory board of Health eVillages with Tullman, but I’m not in regular contact.)

Those hires bring instant credibility, though not necessarily success, and shows, as I’ve said before, that untethered PHRs might stand a chance once providers start addressing the patient-engagement requirements of Meaningful Use Stage 2. Emphasis on “might.” To date, nobody has found a way to get more than a small handful of patients to control their own medical data via PHRs.

Chopra — who once was managing director of the Advisory Board Co. and led open-data efforts as secretary of technology in Virginia prior to joining the Obama administration — and Tullman know the health IT business better than most, but I still cast a skeptical eye on any PHR company until they prove to me they can capture a market. None ever has.

As I alluded to earlier, I was leaving the press room one afternoon at HIMSS14, and there I see former national health IT coordinator Dr. Farzad Mostashari hanging around Gregg Masters and Dr. Pat Salber of Health Innovation Media. It turns out, Masters and Salber had just pulled Mostashari aside to do an interview on video, but they didn’t have anyone to interview him on camera, so they asked me right there on the spot to be the interviewer. Here is the result.

Mostashari, now a visiting fellow at the Engelberg Center for Health Care Reform at the Brookings Institute in Washington, discussed how the years of searching for a business model to coordinate care and engage patients is finally starting to pay off. Always the champion of the little guy in healthcare, Mostashari also brought up the notion of physician-led ACOs, or, as he called it, the “Davids going up against the Goliaths.”

I had pretty much no preparation for this interview. It probably shows. I still think it worked out well.

As I reported for MedCity News at HIMSS14 nearly two weeks ago, CMS Administrator Marilyn Tavenner announced plans to provide unspecified flexibility in claims for Meaningful Use Stage 2 hardship exemptions this year. Tavenner then left without speaking to the media.

The news left a lot of people scratching their heads and waiting for some details. Today, CMS issued some clarification, confirming that there would be exemptions for healthcare providers unable to have EHRs certified to 2014 standards in place for the 2014 reporting year. This is particularly important now because Medicare penalties for not achieving Meaningful Use take effect next year, but they are based on the 2014 reporting year (Oct. 1, 2013-Sept. 30, 2014 for hospitals, the 2014 calendar year for physicians and other individual “eligible providers.”)

The guidance confirms that CMS is aware of the problems caused by the slow pace of certification to the new, 2014 standards that Stage 2 requires. As of today, according to the ONC Certified Health IT Products List (CHPL), there are 3,736 ambulatory and 1,200 EHRs and EHR modules certified to 2011 standards, but just 899 total that meet 2014 certification.

ORLANDO, Fla.—Two days of HIMSS14 have come and gone, and I’m not bouncing off the walls just yet. But I did bounce off the pavement Monday night when I tripped exiting a shuttle bus, and have some facial scrapes to show for it. You will see the evidence whenever Health Innovation Media gets around to posting a video interview I conducted Tuesday afternoon.

Health Innovation Media’s Gregg Masters and Dr. Pat Salber have been camped out near the HIMSS press room since Sunday with their video equipment, querying various newsmakers on various health IT topics, and occasionally having guest interviewers. As I walked out of the press room on my way to the exhibit hall, I said hello to former national health IT coordinator Dr. Farzad Mostashari, who looked like he was just hanging around, but was actually waiting to be interviewed. Masters and Salber asked me if I’d be interested in interviewing Mostashari right there on the spot with no preparation, and with just 15 minutes to get down to the show floor.

If you recall, I did a live interview—yes, streamed live on the Web—last year with Athenahealth honcho Jonathan Bush, beers in hand, for the Health Innovation Broadcast Consortium that Masters and Salber were involved in. (I don’t know the status of that project, as there’s nothing new on that site since last July.) So of course I said yes, and I think it went pretty well. Well, there were a couple of hiccups, as in me thinking we needed to wrap up earlier than we actually had to. And then there’s this:

Now about that facial injury. I think I just need to avoid Orlando. In 2011, the last time HIMSS met here, I needed six stitches above my right eye after I banged my face against the edge of the bathtub in my hotel room. As I arrived for the 2008 conference here, I turned on my phone after landing and got the message that my grandfather had passed away. Just for good measure, I passed through Orlando on my way back from Europe in 2009. As the flight pulled to the gate, the skies opened up with a violent summer thunderstorm, prompting the airport to close the ramp, preventing the ground crew from unloading bags for nearly an hour. I was stuck in the no-man’s land of U.S. Customs for that whole time, where cell phones are prohibited. It was not until I cleared security, took the airport tram to a different terminal, then hustled to the gate that I knew I would make my connecting flight. So yeah, it’s become a pattern.

Anyway, speaking of Jonathan Bush, he is not at HIMSS14 because he is on sabbatical to write a book and who knows what else? Well, here’s a clue. He was spotted at the Winter Olympics in Sochi, Russia, last week with his more famous brother, Billy, host of “Access Hollywood.” (Hat tip to HIStalk for showing this video at HIStalkapalooza Monday night.)

I also heard that Bush is considering a run for political office of some kind, perhaps because it’s, you know, the family business. Anyone care to confirm this?

I do know for a fact that at least one HIMSS attendee is actually seeking office. That would be Dr. Steven Daviss, CMIO of startup M3 Information, maker of a mental health screening app called My M3. Daviss is running for Democratic Central Committee in Baltimore this year. If he wins, he plans on seeking a seat in the Maryland House of Delegates in 2018, in part because he says there is only one other physician among the state legislature.

Daviss himself is on sabbatical from his job as chairman of psychiatry at the University of Maryland’s Baltimore Washington Medical Center in Glen Burnie, Md.

ORLANDO, Fla.—As HIMSS President and CEO hinted at yesterday in his podcast with me, HIMSS today announced the formation of the Personal Connected Health Alliance, in conjunction with the Continua Health Alliance and the HIMSS-owned mHealth Summit.

This short video from HIMSS explains:

Also, Lieber mentioned that HIMSS has not signed on to a letter from 48 organizations—led by CHIME—to HHS Secretary Kathleen Sebelius, calling for more time and flexibility in meeting Meaningful Use Stage 2 requirements., Lieber said HIMSS declined to sign because the requests were, in his opinion, “very vague.”

The undersigned organizations write to express immediate concerns confronting our respective members’ ability to comply with the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program. We recognize the vital role your department has taken in advancing the adoption of health information technology in the United States and appreciate your willingness to be flexible in extending the start of Stage 3 to 2017. We fear the success of the program is in jeopardy, however, if steps are not taken now to address our shared concerns.

Over the next seven months, more than 5,000 hospitals and 550,000 eligible professionals must adopt the 2014 Edition of Certified Electronic Health Record Technology (CEHRT) and meet a higher threshold of Meaningful Use criteria. Failure to do so will not only result in a loss of incentive payments, but also the imposition of significant penalties. With only a fraction of 2011 Edition products currently certified to 2014 Edition standards, it is clear the pace and scope of change have outstripped the ability of vendors to support providers. This inhibits the ability of providers to manage the transition to the 2014 Edition CEHRT and Stage 2 in a safe and orderly manner.

We are concerned this dynamic will cause providers to either abandon the possibility of meeting Meaningful Use criteria in 2014 or be forced to implement a system much more rapidly than would otherwise be the case. The first choice limits the success of the program to achieve widespread adoption of EHR, while the second is highly disruptive to healthcare operations and could jeopardize patient safety. As you know, our members’ number one priority must be to provide safe and high quality care to patients.

Providers need adequate time to learn how to use the newly deployed technology, including examining staff assignments, workflows, and practice processes. If providers move forward, as dictated by the current policy, our concerns regarding rushed implementations are heightened. Furthermore, we believe the “all or nothing” approach – where missing a single objective by even a small amount results in failure for the program year – compounds our concerns.

For these reasons, our organizations strongly recommend that HHS:1. Extend the timelines providers have to implement 2014 Edition Certified EHR software and meet the Program requirements (Stages 1 and 2) through 2015;2. Add flexibility in Meaningful Use requirements to permit as many providers as possible to achieve success in the program.

Given that we are well into 2014, immediate attention to these concerns is warranted. This additional time and new flexibility are vitally important to ensure that hospitals and physicians continue moving forward with technology to improve patient care. By making such changes, HHS would be demonstrating needed flexibility to maximize program success, without compromising momentum towards interoperability and care coordination supported by health IT.

We remain committed to the success of the program and look forward to hearing from you on this important matter. Please contact Jeffery Smith, Senior Director of Federal Affairs, CHIME, (jsmith@cio-chime.org) should you have any questions. Thank you for your consideration.

Sincerely,

AMDA-Dedicated to Long Term Care Medicine
American Academy of Allergy, Asthma & Immunology
American Academy of Dermatology Association
American Academy of Family Physicians
American Academy of Home Care Medicine
American Academy of Hospice and Palliative Medicine
American Academy of Neurology
American Academy of Ophthalmology
American Academy of Orthopaedic Surgeons
American Academy of Otolaryngology—Head and Neck Surgery
American Association of Neurological Surgeons / Congress of Neurological Surgeons
American College of Cardiology
American College of Osteopathic Family Physicians
American College of Osteopathic Internists
American College of Osteopathic Surgeons
American College of Physicians
American College of Radiology
American College of Rheumatology
American College of Surgeons
American Health Information Management Association
American Hospital Association
American Medical Association
American Osteopathic Academy of Orthopedics
American Osteopathic Association
American Psychiatric Association
American Society for Clinical Pathology
American Society for Gastrointestinal Endoscopy
American Society for Radiation Oncology
American Society of Anesthesiologists
American Society of Cataract and Refractive Surgery
American Society of Hematology
American Urological Association
America’s Essential Hospitals
Association of American Medical Colleges
Catholic Health Association of the United States
Children’s Hospital Association
College of Healthcare Information Management Executives
Federation of American Hospitals
Heart Rhythm Society
Infectious Diseases Society of America
Medical Group Management Association
National Rural Health Association
North American Spine Society
Premier healthcare alliance
Society for Cardiovascular Angiography and Interventions
Society of Thoracic Surgeons
The Endocrine Society
VHA Inc.

Yes, that is kind of vague, but that’s what you get when you involve four dozen organizations. Will it be effective? As I mentioned yesterday, ONC Chief Medical Officer Jacob Reider, M.D., hinted that there will be news about Stage 2 flexibility, likely Thursday morning at a joint ONC-CMS town hall. Reider made that statement at the CIO Forum, hosted by CHIME.

It’s time for my annual podcast interview with HIMSS President and CEO Steve Lieber, this time from the Orange County Convention Center in Orlando, Fla., on the day before the official opening of the 2014 HIMSS Conference, rather than in his Chicago office a week or so in advance.

Lieber reiterated HIMSS’ position that the federal government should extend the attestation period for Meaningful Use Stage 2 by one year. I wasn’t there, but today at the CIO Forum, one of the preconference educational symposia, ONC Chief Medical Officer Jacob Reider, M.D., hinted that there will be an announcement on Stage 2 flexibility, possibly Thursday morning at a joint ONC-CMS town hall. That session will feature CMS Administrator Marilyn Tavenner and new national health IT coordinator Karen DeSalvo, M.D. I’ve never heard either of them speak, and now I’m excited to be covering that session.

We also discussed other aspects of healthcare reform, trends in health IT and expectations for HIMSS14. Of note, on Monday morning, HIMSS and two other organizations will announce a new initiative on “personal connected health.”

Near the end, I reference the podcast I did last week with Dr. Ray Dorsey about remote care for Parkinson’s patients. For easy reference, here’s the link.

This is, I believe, the seventh consecutive year I have done a podcast with Lieber at or just before the annual HIMSS conference. Another interview that has become somewhat of a tradition won’t happen this time, as Athenahealth CEO Jonathan Bush is not making the trip to Orlando this year.

0:40 “It’s time to execute.”
1:40 Challenges for small hospitals and small practices
3:10 New ONC EHR certification proposal and continued questions about Meaningful Use Stage 2
5:00 Prioritizing with multiple healthcare reform initiatives underway, including proposed SGR repeal
6:30 Surviving ICD-10 transition
7:35 HIMSS’ position on MU2 timelines
9:05 Remember “macro objective” of Meaningful Use
10:00 Letter to HHS from organizations not including HIMSS calling for what he says are “very vague” changes to MU2 criteria
11:40 Things in MU2 causing providers fits
13:05 Fewer EHR vendors certified for 2014, but more HIMSS exhibitors
15:00 What this means for providers who bought products certified to 2011 standards
17:20 Progress on Meaningful Use so far
21:00 Looking toward Stage 3
22:42 What healthcare.gov struggles might mean for health IT
25:35 Other aspects of the Affordable Care Act being lost in the public debate
27:10 Political considerations related to health IT
29:40 Patient engagement and new HIMSS exhibitors
32:20 Why healthcare spending and provider shortage forecasts don’t account for efficiency gains made from technology and innovation
35:10 Demographic challenges for healthcare
35:45 Shift from hospitals to ambulatory and home care and consolidation of provider organizations

Today is the fifth anniversary of the American Reinvestment and Recovery Act being signed into law, which also means today is the fifth anniversary of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was rolled into the $831 billion stimulus bill. HITECH introduced “meaningful use” into the lexicon, and for that, it has had a lasting effect.

Through the end of 2013, the program had paid out more than $19 billion in Medicare and Medicaid incentives for EHR usage, and healthcare is still a mess. However, all of that money is for Stage 1, and the goal for the first stage was mostly to get technology in place. Stage 2, which is just getting started, is about interoperability and data capture, while Stage 3, which will not start before 2017, will be focused on actually improving outcomes. It is not until the third stage where we are supposed to see real gains in healthcare quality, though we should start seeing some efficiency improvements in Stage 2.

Penalties for not achieving Meaningful Use kick in next year, though that could change. According to Medscape, the new bill to repeal the much-reviled Medicare sustainable growth rate calls for bringing Meaningful Use, the Physician Quality Reporting System (PQRS) and Medicare’s value-based payment modifier under a proposed new program called the Merit-Based Incentive Payment System (MIPS). This program would eliminate Meaningful Use penalties after 2017, but would base incentives and penalties on more factors than just EHR usage.

On a lighter note, MMRGlobal, the controversial PHR vendor that has been aggressive in defending its many patents but that also has, like every other vendor of untethered PHRs, had trouble landing many customers, has signed on actress and cancer survivor Fran Drescher as a spokesperson. There’s a video on the company’s Facebook page, with a teaser to “Watch For MMRGlobal on TV!” Draw your own conclusions.

On an even lighter note, digital media producer Gregg Masters has started the #HIMSSPickupLines hashtag on Twitter. A few samples:

After a couple of weeks of uncertainty, I now know I will be covering HIMSS for MedCity News. A lot of vendors and PR firms have of course pitched me for meetings, and the reality is, I’ve not always found vendor meetings all that interesting. In fact, the absolute worst thing about the annual HIMSS conference—and I’ve covered every one since 2002—is the few weeks beforehand, when I’m trying to juggle my schedule.

I have occasionally double-booked or simply forgotten to enter appointments into my calendar, but these things do happen when you are juggling dozens if not hundreds of e-mails, you don’t have a secretary and, oh, by the way, have regular work to do a the same time. Sometimes I’ve scrambled to change appointments up to the moment I get on the plane. It’s just a mess most of the time because of the sheer volume of requests and the need to fit it into my normal routine. (Interestingly, and scarily, it’s similar to how healthcare often operates, and mistakes made in healthcare can be deadly.)

The bottom line is, there are more than 1,200 vendors at HIMSS these days, and there is one of me. I can maybe meet with 10-12 of them over the five days of HIMSS, counting Sunday and Thursday, and most of the vendors have gone home by Wednesday evening. One thing a I’ve found is that lot of vendors don’t understand that there are also more than 300 educational sessions to choose from; HIMSS doesn’t just happen in the zoo known as the exhibit hall. I tend to find a lot of great stories from those sessions, so I make them a priority.

Anyway, I have about 10 stories to do for MedCity News during and immediately after HIMSS, and some have fairly specific requirements. (I also have to find time to, you know, write the stories. Sometimes, it’s a trade-off between covering a session/meeting with a vendor and doing my work. Doing the work necessarily wins. Two years ago in Las Vegas, I had to cancel two or three vendor meetings after CMS and ONC dropped the proposed Meaningful Use Stage 2 rules during a town hall-style session. If you recall, the thousands of people trying to download the proposal all but crashed the public Wi-Fi network at the Venetian.)

Two stories are about companies I discover at the new Startup Showcase. If you’re among the startups on display there, let me know. I’ve got one story to do on the Intelligent Hospital Pavilion and another on the Interoperability Showcase. I’ll probably just spend an hour or so walking through and asking questions, but if you’re there and think you have a compelling angle for me, I’m listening.

That’s four stories right there. Three more are from coverage of specific sessions, so those are already booked. I’ve also got three opinion/analysis pieces to write in the week after the fact, and I’m pretty flexible on those. I’m just going to see what I discover and what jumps out at me. A theme usually emerges by the second day.

Away from the madness, I will be at the fifth annual New Media Meetup on Tuesday evening, Feb. 25, hosted by the one and only John Lynn, who also hosts this very blog as part of the Healthcare Scene network. It’s free, but there is limited space, so you do need to preregister.

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